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10
In November 2016, the Association of Medical
Specialists (ASMS) and the NZMA surveyed
members for their views on whether they
prescribed unnecessary tests or treatments,
and if they were aware of the Choosing Wisely
campaign, which was due to be launched
the following month. Signifcant numbers of
responses were received, with most NZMA
respondents working in general practice and
ASMS respondents covering SMOs working in
hospitals across a range of specialities.
From the survey results, it is clear that
many doctors are already taking a nuanced
approach to determine whether certain tests,
treatments and procedures are appropriate
for their patients. Moreover, they are typi-
cally doing so after discussion, negotiation
or shared decision-making with patients.
However, considerably more NZMA respondents
considered that unnecessary testing, procedures
or treatments was either a ‘serious’ or ‘very
serious’ issue in their current area of practice
than indicated by ASMS respondents (56.6% vs.
46.4%).
And NZMA members suggested they were
more likely than their ASMS counterparts to
advise against and still provide a test, procedure
or treatment they deemed to be unnecessary
(22.5% vs 9.7%). This is consistent with the
fnding of a US study that found primary care
physicians feel more pressure from patients for
tests and procedures.
The overriding theme that emerged from
respondents’ comments was that the decision
whether to provide an unnecessary test,
procedure or treatment was not a clear-cut
issue.
The problem is that these categorical responses
don't quite capture the real world of uncer-
tainties and complicating factors. How
reasonable and persuadable is the patient/
parent? How likely to complain, seek another
opinion etc. How certain am I? It is always a
dynamic process.
A key theme that emerged in comments from
ASMS respondents was that they believed the
issue was linked more to requests from other
members of the healthcare team— including
from junior doctors, GPs, other specialists and
nursing staff—than from patients. However,
responses—particularly from the NZMA
respondents—also suggested the issue was
partly driven by patient expectation, not least
by those from higher socio-economic back-
grounds, and those who had consulted other
registered or ‘alternative’ health practitioners,
FEATURE